14 Feb 2024
by Policy, Practice and Innovation Team

The King’s Fund new report examines why the long-held ambition to place greater emphasis on primary and community care has not been achieved and proposes solutions to make it a reality.

The report says the health and care system in England needs to be radically refocused to put primary and community care at its core if it is to be effective and sustainable. It argues that the failure to grow and invest in primary and community health and care services, despite successive government commitments, is one of the most significant and long-running policy failures of the past 30 years.  

The report says it was clear from the research that the financing of hospital services takes priority for politicians and system leaders over financing for prevention or care services.

The researchers further noted the difference in value reflected in the overall level of pay for staff working in primary and community health and care services compared with staff working in acute hospital roles.

The report cites a particular issue about the way in which homecare is commissioned, the Homecare Association raised with researchers, which results in pay being less attractive than for similar roles in hospital settings.

We explained that in homecare everything is measured in minutes - we asked them to imagine a scenario where in a hospital, a nurse was only paid for the minutes spent by a patient’s bed, and not for when they walk from one patient’s bed to another. A wholly unsatisfactory situation which happens in homecare every day.

The report calls for future funding to be directed into a comprehensive plan to refocus the health and care system towards primary and community care, with a series of steps to begin the shift:

  • Vision: A clear vision for bolstering primary and community services, with all policies aligned to achieving that vision, and the political will to stick to the vision over the long term.
  • Funding: Future growth in health and care funding needs to be targeted at primary and community services 
  • Workforce: Incentivise more staff to work in primary and community services through pay, status, career progression, and by considering mandatory primary and community training placements for clinicians and leaders.
  • Estate: Prioritise investment in primary and community care buildings and equipment and cut red tape so organisations can better pool the space they have. 
  • Flexibility and accountability: Give local health and care leaders more flexibility to meet local needs and hold them to account for improving overall patient care, rather than waiting lists.
  • Social care: Without reform of the ailing social care system, the ambition of ‘care closer to home’ cannot be fully realised.  

To conduct the research, the King’s Fund interviewed stakeholders across diverse roles relating to health and care, engaged with stakeholders, including practitioners, patient representatives, managers, and policymakers, and reviewed existing research and evidence from the past 30 years. The Homecare Association contributed to this research, on behalf of the homecare sector.

King’s Fund press release

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